UIC Financial Assistance Application UIC Financial Assistance Application Note: Please provide accurate and detailed information so we may evaluate Zakat requests promptly and effectively. RM_StatsFirst Name *Spell out full name exactly as it appears on your identity document. You will be asked to present a copy of identification document during application processingLast Name *Email *Contact Number *Address * Address Line 1 * Address Line 2 City * State or Region Alabama Alaska Arizona Arkansas Armed Forces America Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State or Region * Country * ZIP * Please note that as per policy, financial aid is given to people living in UT (Salt Lake, West Jordan City), USA only.Gender * Male Female Are you a US Citizen or Permanent Resident? * Yes No Select the official ID information you providing for this application * US Driving License US State ID Green Card US Passport SSN Please specify the ID number for the ID you have selected in previous questionMarital Status * Married Single Widow Separated Divorced Spouse First NameSpouse Last NamePlease explain if you have any permanent or temporary disability or serious illness?Declaration Terms and Conditions *I agree that the information provided by me is 100% true.I agreeFull Name *Date * Note: It looks like JavaScript is disabled in your browser. Some elements of this form may require JavaScript to work properly. If you have trouble submitting the form, try enabling JavaScript momentarily and resubmit. JavaScript settings are usually found in Browser Settings or Browser Developer menu.
